Provider Demographics
NPI:1932228848
Name:MOBLEY, CONSTANCE MARIE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MARIE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 MAIN STREET
Mailing Address - Street 2:OUTPATIENT CENTER, FLOOR 22
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-441-5451
Mailing Address - Fax:713-791-5277
Practice Address - Street 1:6445 MAIN STREET
Practice Address - Street 2:OPC 22
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-441-5451
Practice Address - Fax:713-791-5277
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115469204F00000X, 208600000X
TXP9403204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1154690Medicaid
TX340202602Medicaid
TX340202601Medicaid
TX8EJ545OtherBCBS
TXP01507451OtherRR MEDICARE
TX340202601Medicaid